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1 March 2000
IN THIS ISSUE . . .
• Concepts and Methods in Epidemiology: • Norms and Standards in Epidemiology:
An integrated approach to Communicable Disease Surveillance Case definitions - Tuberculosis and neonatal tetanus
1
WHO. Weekly Epidemiological Record, No. 34, 1999, pp. 281-285
2
WHO Report on Infectious Diseases – Removing obstacles to healthy development.
Geneva, WHO, 1999. (http://www. who.int/infectious–disease-report/)
has not been eliminated. Thus we can estimate that about 40 Costa Rica 143 0.39 14 0.04 43.4
Cuba 597 0.54 246 0.22 98.8
million people live in areas where leprosy is still a public
Dominican Rep. 346 0.42 220 0.27 96
health problem, in countries of Latin America where leprosy
Ecuador 373 0.31 110 0.09 100
is considered to be eliminated at the national level. Further,
El Salvador 43 0.07 5 0.01 100
of the 191 entities forming the first sub-national level, 37 (19%) Guatemala 50 0.04 5 0 100
have not eliminated leprosy. Haití 924 1.23 50 0.07 ...
Honduras 76 0.12 ... ... ...
Therefore, elimination strategies should be sustained
Mexico 2,320 0.24 415 0.04 78
even when a given country has reached elimination of lepro-
Nicaragua 114 0.26 42 0.1 100
sy at the national level. Two steps are involved in the inte- Panama 15 0.06 4 0.01 86.7
grated approach to insure political commitment and technical Paraguay 652 1.25 362 0.69 100
cooperation: Peru 266 0.11 107 0.04 89.5
Uruguay 14 0.04 10 0.03 100
• The first step is confirmation, with prevalence as an indi-
Venezuela 1,344 0.58 662 0.28 99.6
cator. In the confirmation stage, entities are classified
according to their respective estimated prevalence rate Latin America 88,053 1.86 47,438 1.00 96.9
and different strategies are put in place in order to eval- Sources: 1) SIL/PAHO; 2) WHO; 3) Population: PAHO/WHO, Health Situation in the
uate hidden prevalence. Once the search and evalua- Americas - Basic Indicators 1998
tion of the hidden prevalence are achieved, if it is con- (*) Estimated (… ) Data not available
firmed that the prevalence is below one case per 10,000
population, other strategies will be implemented in order the introduction of innovative and flexible systems of admin-
to confirm this “status”, using detection (incidence) as istration of MDT; and 5) monitor actively the situation to
an indicator through the promotion of community aware- adopt appropriate actions to solve the detected problems
ness and training of local health teams. rapidly.
• At a later stage, when no case is detected after a five- In order to accelerate progress towards elimination of
year period, the progressive introduction of an epidemi- leprosy in Brazil, Paraguay and Suriname and to build inno-
ological surveillance system adequate for a low preva- vative strategies to validate and consolidate the results ob-
lence scenario is proposed, using tools such as sentinel tained in the other countries, a pro-active and sustained ef-
surveillance and zero reporting, until the interruption of fort is proposed, through the implementation of a Regional
transmission is reached, which means that the area is no Plan coordinated by PAHO/WHO. As agreed during the Vene-
longer endemic for leprosy. zuela conference, this action plan will be elaborated in 2000.
The “Global Alliance” proposed the following key strat- From the time of its formulation, it should count on the full
egies for the 2000-2006 period: 1) implement the diagnostic commitment of a wide spectrum of partners, and a close col-
and treatment of leprosy in all the services of the endemic laboration between health care providers and users at every
area; 2) guarantee the availability of free MDT treatment in level of leprosy care. The objectives of the Regional Plan
health centers through appropriate logistic; 3) motivate peo- should be to prevent the re-emergence of the disease as well
ple to ask for treatment, through creative and higher quality as, through the use of new technologies, the total interrup-
interventions, to spread the information on signs and symp- tion of its transmission, i.e. the eradication of leprosy from
toms of the disease; 4) ensure high healing indices through the Americas, .
2
Argentina, Bolivia, Colombia, Cuba, Mexico, Peru, Dominican Republic, and Source: PAHO. Communicable Diseases Program. .........
Venezuela
Death certificates1 corresponding to the period of the The health sector is divided into three sub-sectors: a
study were reviewed, in which the causes of deaths were public health sector, a social works sector and a private sec-
coded according to the International Classification of Dis- tor that includes pre-payment and personal fee-for-service
eases (ICD-9), and population projections from the National mechanisms. The per capita health expenditures were US$795
Institute of Statistics and Census (INDEC)2 were used as in 1995, of which 45% corresponded to the public sector and
well. The causes of death were classified in 15 groups, as in
previous studies.3 The mortality rates were adjusted by age
and sex, and YPLL were calculated for every group of Figure 1
province has its own constitution, with its own executive, Neuquén
GDP of US$9,066. The parity of the Peso to the US dollar has Cuyo
Santa Cruz Centro
1 Ministry of Health, Argentina. Vital Statistics. Basic Information.1986- 1995
2 INDEC: Statistical Report of the Republic of Argentina, 1996
3 Ministry of Health and Social Action, Argentina and Pan American Health Orga-
nization, “Perspectiva Epidemiológica Argentina” 1996. The 15 groups of causes
are: cardiovascular diseases, cancer, infeccious diseases, accidents, other abdomi-
nal diseases, respiratory diseases, metabolic causes, urinary diseases, perinatal Tierra del Fuego
causes, violence, birth defects, other perinatal causes, maternal causes, ill-defined
and other causes.
While the total mortality rate declined from 8.2 per 1,000
in the 1986-1988 period to 7.8 per 1,000 in 1995, the total age-
adjusted mortality rate showed significant differences be-
tween the regions, with higher figures in the northern re-
gions than the rest of the country. The distribution of the
leading causes of death was heterogeneous as well. Deaths
from infectious diseases occurred in greater proportion in
the northern regions with lower-income population. Between
1986 and 1994 for example, mortality rates due to infectious Rates per 100,000 population
diseases in the northern provinces went from 69.2 to 83.7 per
69.2 to 83.7
100,000, while rates in Patagonia ranged from 22.5 to 43.6
62.8 to 69.2
(Figure 2). Meanwhile, deaths due to cancer had a higher
51.4 to 62.8
proportional weight in the Center and South. In Patagonia
43.6 to 51.4
and in the center for example, mortality rates due to cancer 22.5 to 43.6
fluctuated between 163 and 194, while rates in the northwest
went from 86 to 124 per 100,000 population (figure 3). Higher
Figure 3 - Age-adjusted mortality rates for cancer Figure 4 - Age-adjusted mortality rates for cardiovascular diseases,
Argentina, 1992-1994 Argentina, 1986-1994
es, birth defects, infectious diseases and violences took Other perinatal
Maternal
greater weight when the YPLL were considered. Other causes
Infant mortality declined from 26.9 per 1,000 live births Proportion of YPLL Proportion of the total deaths
in 1986 to 18.8 in 1997 but this reduction differed in the
different regions. Patagonia showed the more significant
decrease, with 38.7%, compared to a reduction of only 28.4%
in the Northeastern region (Figure 7). This difference is Figure 7 - Changes in infant mortality by region,
Argentina, 1986-1997
even more remarkable when considering that Patagonia had
one of the lowest, and the northeast one of the highest
Patagonia 24.8% 38.7%
infant mortality rates (IMR) at the beginning of the period. 15.2%
Consequently, inequity is currently greater than at the be- 8.3% 34.6%
Cuyo
ginning of the period. Significant infant mortality gaps were 18.5%
Abortions
15.78% 28.15%
Related to pregnancy, undefined
5.34%
Related to prenatal care
Amoebiasis Cuba
(see Meetings, congresses and seminars, reports on) dengue, 18:2
(See also Meetings, congresses and seminars, calendar of)
Antimicrobial resistance in the Americas
(see Meetings, congresses and seminars, reports on) D
Demographic
Aromatic hydrocarbons, potential effects of workers’ health, (See indicators)
Colombia, 1996, 18:3
Dengue
B Cuba, 18:2
Blood re-emergence, in the Americas, 18:2
bank situation serological proficiency test, 18:2
in the Region of the Americas (1994-1995), 18:1 serological study, Inhibition ELISA, 18:2
serological markers for communicable diseases, in Latin (See also Publications)
America (1996), 19:3
safety in the Americas, 20:2 Diphtheria, case definition, 20:4
Brazil E
integrated information network for health, development, 18:4 El Niño, impacts on health, 19:2
H Lead in gasoline
Hantavirus elimination, Latin America and the Caribbean, 18:3
(See Publications)
Leprosy
Health (See Meetings, congresses and seminars, calendar of)
El Niño, impacts, 19:2
in the Americas, 1998, 19:3 Lymphatic Filiariasis, in the Americas, 18:4
inequity, measuring, 20:1
Integrated information network, development, Brazil, 18:4 M
older persons of Latin America and the Caribbean, 18:2 Malaria
situation, basic indicators, in the Americas, 18:1 case definition, 20:2
situation analyses, 20:3 in the Americas, 1996, 18:3
situation and trends in the Americas, by subregion (1980-
1998), 20:1 Maternal and Child Health
worker’s health, effects of exposure to aromatic hydrocarbons, (see Publications)
Colombia (1996), 18:3
(See also Publications) Measles
case definition, 20:3
Health for All by the year 2000 eradication in the Americas by the year 2000, Partnership, 20:2
third evaluation of the Implementation, Region of the Americas,
18:4 Meetings, congresses and seminars, calendar of
AIDS, V Pan American Conference on, Peru, 1997, 18:1
Health statistics emerging infectious diseases, international conference on, USA,
(See Publications) 1998, 18:3
environmental Engineering and Health Sciences, international
Hurricane Mitch, impact in Central America, 19:4 symposium on, Mexico, 1998, 19:2
epidemiology
I III Chilean congress of, Chile, 1997, 18:2
IMCI IV Chilean congress of, Chile, 1998, 19:4
(See Childhood illness) I Venezuelan congress of, Venezuela, 1997, 18:1, 18:2
VIII Colombian congress of, Colombia, 1997, 18:2
Indicators geographic Information Systems and Health, Meeting on, USA,
basic (1996), 18:1 1998, 19:2
basic (1998), by subregions, 19:3 health Crisis and the Internet, Colombia, 1997, 18:2
basic (1999), Selected, by country leprosy, IX Congress of the Brazilian Association of, Brazil,
population, health resources, access and coverage, 20:3 1997, 18:1
mortality, 20:3 nutrition, Congress of the Latin American Nutrition Society,
mortality differences by gender, 20:4 Guatemala, 1997, 18:1
demographic and morbidity, 20:4 sexually transmitted diseases, XI Latin American Congress on,
growth retardation, in children, 19:1 Peru, 1997, 18:1
(See also Publications) tobacco or health, I Iberoamerican Conference on, Spain, 1999,
19:2
Inequity
in health, measuring, 20:1 Meetings, congresses and seminars, reports on
income, Risks of dying, 20:4 Amoebiasis, consultation meeting with experts, Mexico,
1997, report on, 18:1
Insecticide Antimicrobial resistance in the Americas, Pan American
susceptibility tests, results, four Central American countries conference on, 20:2
(1994-1997), 18:3 Onchocerciasis, Inter American Conference, Oaxaca,
Mexico,1996, report of, 18:4
International Classification of Diseases Scientific Advisory Committee (SAC) of the Caribbean
tenth Revision (ICD-10), Implementation, 18:1 Epidemiology Center, 1997, meeting of, 18:1
Pertussis, case definition, 20:4 Violence, Cultural norms and attitudes, selected cities in the Region
of the Americas, 18:4
Plague, case definition, 20:1
W
Poliomyelitis, case definition, 20:2 WHO
International Classification of diseases, collaborating
Publications centers, 19:3
Control of Communicable Diseases, 16th Edition, 18:4
Hantavirus in the Americas: Guidelines for Diagnosis, Treatment, Whooping cough
Prevention, and Control, 20:2 (See Pertussis)
Health and environment analysis and indicators for decision-
making, World Health Statistics Quaterly, 18:3 Worker’s health, exposure to aromatic hydrocarbons and their
Health Conditions in the Caribbean, 1997, 18:4 potential effects, Colombia (1996), 18:3
Health in the Americas: 1998 Edition, 19:3
Health Situation in the Americas: Basic Indicators 1998, 19:3 Y
Health Situation in the Americas: Basic Indicators 1999, 20:3 Yellow fever, case definitions, 20:1
Health Statistics from the Americas, 1998 Edition, 20:3